Drugs for PLHIV

The Jakarta Post ,  Jakarta   |  Thu, 11/01/2007 4:52 PM  |  Opinion

The provision of anti-retroviral drugs to people living with HIV (PLHIV) in Indonesia is a complex topic, and Joshua Livestro's article titled ""National pride vs. common sense"" (The Jakarta Post, Oct. 25) is a timely review of the history.

However, I'd like to clarify several points. First, I think most people living with HIV in Indonesia feel a debt of gratitude to those who have made it possible for them to receive these life-saving drugs.

Back in mid-2004, it would have seemed unrealistic to suggest that most of those who needed it would have access to free treatment within three years. Yet, while the system for provision of this treatment still leaves much to be desired, it has not only saved the lives of a significant number of people, but has also offered hope.

Further, although WHO continues to provide important technical support in scaling up access to treatment for PLHIV in Indonesia, they are not involved in actual provision of this treatment and provide no funding for this.

On the other hand, while Doctors Without Borders did provide drugs and played a crucial role by demonstrating the feasibility of this treatment, particularly in Papua, they are no longer directly involved; their task is being continued by the local groups that they trained and developed.

Now, apart from the national budget, the major funding support for this program comes from the Global Fund to Fight AIDS, TB and Malaria. Since the early years of this decade, Indonesia's strategy has been to rely on generic versions of anti-retroviral drugs, primarily from India.

Patented versions have only been used where generics could not be obtained. Sadly the number currently receiving this treatment is well below the 15,000 quoted in the article. The latest data from the Health Ministry as of June 2007 show that less than 10,000 have actually started this therapy in the more than 200 AIDS referral hospitals around the country. However, less than 60 percent of these remain on therapy. Sadly almost one in four subsequently died.

Losses at this level have been seen in most HIV treatment programs in developing countries, so this is not unique to Indonesia.

It is becoming increasingly clear that the community, particularly PLHIV, plays a crucial role. However, neither government officials nor healthcare professionals have traditionally welcomed community and patient involvement, and changing this attitude represents a significant challenge.

CHRIS W. GREEN
Jakarta

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